Module 3 Unit C Practice Quiz Flashcards
A person is experiencing first trimester bleeding and is 9 weeks’ gestation by certain dates.
What non-serious/less serious cause of first trimester bleeding is most likely, given the timing of the bleeding?
Subchorionic hemorrhage
[Timing of initial bleeding is typically between 8-10 weeks gestation.]
A patient presents for a first OB visit and mentions that they have a brother with Down Syndrome. What is the most appropriate next step to take as a result of this finding?
Further explore the patient’s thoughts about their brother’s condition related to their own pregnancy
[Although both B and C are reasonable recommendations. The first and most appropriate step at this time is to explore the patient’s thought’s about their brother’s condition related to their own pregnancy. Remember, patient preferences and values often steer the direction of these sensitive discussions.]
A woman presents for prenatal care at 6 weeks gestation. While taking her family history, the woman mentions that she has a brother who has developmental delays and she does not know the cause. Which of the following would be most important to include in the care plan for this woman at this visit?
referring her to a genetic counselor
[The most important thing to include in the care plan for this woman at this visit is a referral to genetic counseling. Here a genetic counselor could dive deeper into her family history and provide their recommendations regarding genetic testing and or carrier screening. From there it could be determined if this patient wants to consider genetic screening, including the nuchal (between 10-13 wks) and blood work (sequential, Cf DNA, Etc.), and at a later date, the anatomy scan (between 18-20 wks).]
Which of the following is the preferred statement to use when explaining the risk of Down Syndrome? (For purposes of this question, assume that the patient has a 1:100 risk of Down Syndrome).
a) “The relative risk that your baby will have Down Syndrome is lower than the risk of it having a Neural Tube Defect.”
b) “The chance that your baby will have Down Syndrome is less than 2 percent.”
c) “The chance that your baby will have Down Syndrome is 1 in 100, and there is a 99% likelihood that your baby will be normal.”
d) “The chance that your baby will have Down Syndrome is 1 in 100, and there is a 99 in 100 likelihood that your baby will not have Down Syndrome.”
d) “The chance that your baby will have Down Syndrome is 1 in 100, and there is a 99 in 100 likelihood that your baby will not have Down Syndrome.”
The sensitivity of a test is the:
True positive rate
[The sensitivity of a test is its ability to correctly identify the people who have the condition. In other words, the true positives.]
A patient requests an ultrasound “to be sure everything is okay with the baby.” How should the clinician respond, keeping shared decision-making and sound practice in mind?
Ask the patient about her concerns and discuss the factors pertinent to making a decision about ultrasounds.
[It is best to first explore the patient’s concerns and preferences before proceeding to establish a plan of care.]
Assuming no prior lab results are available, which of the following lab tests are most appropriate when the CNM/WHNP suspects a missed abortion?
Blood type/Rh factor
[If you are suspicious of a MAB, you would not need a UPT as that will likely remain positive for a while and would have very little clinical value. You would however, want to know if the patient was Rh negative, in which case, you would likely give Rhogam (unless it was documented that the FOB was also Rh negative).
Coagulation studies and liver enzymes are “zebras” and would not typically be performed when suspicious of a MAB.]
Offering informed consent when discussing genetic screening options is an example of which ethical principle?
autonomy
[A patient cannot be autonomist, if they do not have accurate and appropriate information from which to make a fully informed decision.]
A 22-year-old G1P0 at 8 weeks gestation presents to clinic with a report of cramping and bright red spotting for the last 2 days. The patient is tearful that something may be wrong. Of the following, the most appropriate action would be to:
Perform speculum and bimanual exams
[A speculum exam would allow you to determine if her cervix is dilated, vaginal bleeding, and if there is potential vaginitis which may also be a source of spotting during pregnancy. A bimanual exam would help you assess if her uterus is appropriately sized for gestational age. Now, in some institutions, a patient is automatically scheduled for a TVUS before being added to your schedule when there is a c/o 1st trimester vaginal bleeding. The take away here is that you would first need to collect more information!]
A 22-year-old G3P1011 at 7 weeks gestation by LMP presents to clinic reporting an episode of spotting yesterday the size of a 50-cent piece. She reports occasional headache and fatigue. Her uterus is enlarged on pelvic exam. The MOST important data to gather at this visit is:
Presence of pain
[The key here is the most important piece of information to gather. Early pregnancy dated by LMP, w/ spotting, you always want to take into consideration the possibility of an ectopic. The presence of pain, most suspiciously unilateral pain, would raise your concern for an ectopic pregnancy.]
A patient presents at 9 weeks gestation with a report of persistent bright red bleeding for 2 days, similar to a heavy period. The patient had their first visit one week ago and had no concerns. Today, other than the bleeding, the patient feels well. The next most important step in the clinician’s care is to:
Obtain an ultrasound to assess fetal cardiac activity and other indicators the health of the pregnancy.
[Given that this patient has had persistent bleeding (like a heavy period), the first thing you would want to do is establish viability. Given her gestational age, the best way to determine viability is via US.
Although Chlamydia and gonorrhea can cause vaginal bleeding, it is not typically heavy bleeding, and may be something you’ve considered evaluating for, AFTER obtaining an US.
You would want to complete your assessment of the patient prior to proceeding with consultation.
A CBC would typically be considered after first obtaining an US. Coag studies are not routinely drawn and certainly would not be the MOST important data to collect.]
What is most appropriate to offer a person at 13 weeks gestation who has a positive first trimester screening test (NT and serum screen)?
referral to a genetic counselor
[Although all of these options may be appropriate at some point, the most appropriate thing to do is to refer to a genetic counselor or perinatologist (depending on the facility resources). The perinatologist would counsel the patient on all of their options and will often be the one to perform any higher level ultrasounds, diagnostic testing (if elected), and loop back with the referring provider to discuss if the patient has elected for a termination.]
A patient is excited to present to prenatal care because she had a positive pregnancy test at home 3 days ago. A urine pregnancy test in the office is also positive. The patient feels great today without any cramping, pain, or bleeding.
The patient thinks her last period might have started about 4-5 weeks ago but she can’t remember whether it was a normal period or if it started when she expected it to start. Upon further discussion, she says that perhaps she’s wrong about the date? Her periods are fairly irregular.
The clinician and patient agree that an ultrasound is the best way to date the pregnancy so the patient undergoes a vaginal ultrasound in the office. The ultrasound results are unclear with a gestational sac visible but no embryonic pole or cardiac activity can be identified.
How should the clinician proceed?
Offer the patient a repeat ultrasound in one week with specific precautions to call immediately if she experiences any bleeding or pain.
[This patient is possibly 5 weeks.
This patient is also possibly further along with a MAB.
Until cardiac activity is seen, we cannot confirm viability.
Returning in 1 week we should also be able to see a yolk sack, embryonic pole, and possibly cardiac activity. ]
A patient is in clinic for a first prenatal visit at 12 weeks by sure, normal LMP and regular cycles. The clinician finds the uterine fundus at the level of the symphysis. The clinician uses a Doppler but is unable to hear fetal heart tones. What should the clinician conclude about whether this is an expected finding?
FHTs should be audible by Doppler in this patient so further evaluation is warranted.
[By 12 weeks EGA, you should be able to obtain FHTs via doppler, therefore, further evaluation is warranted. Now…adipose and uterine position can make it more or less difficult to hear fetal heart tones. If an unsuccessful attempt is made to hear fetal heart tones, the pregnant person should be given an opportunity to return in a week or so to try again]
What is the typical human chorionic gonadotropin (hCG) pattern for a hydatidiform molar pregnancy?
Abnormally high levels of hCG
